Access to Palliative Care Among Patients Treated at a Comprehensive Cancer Center
Open accessAbstract
Background.: Palliative care (PC) is a critical component of comprehensive cancer care. Previous studies on PC access have mostly examined the timing of PC referral. The proportion of patients who actually receive PC is unclear. We determined the proportion of cancer patients who received PC at our comprehensive cancer center and the predictors of PC referral. Methods.: We reviewed the charts of consecutive patients with advanced cancer from the Houston region seen at MD Anderson Cancer Center who died between September 2009 and February 2010. We compared patients who received PC services with those who did not receive PC services before death. Results.: In total, 366 of 816 (45%) decedents had a PC consultation. The median interval between PC consultation and death was 1.4 months (interquartile range, 0.5–4.2 months) and the median number of medical team encounters before PC was 20 (interquartile range, 6–45). On multivariate analysis, older age, being married, and specific cancer types (gynecologic, lung, and head and neck) were significantly associated with a PC referral. Patients with hematologic malignancies had significantly fewer PC referrals (33%), the longest interval between an advanced cancer diagnosis and PC consultation (median, 16 months), the shortest interval between PC consultation and death (median, 0.4 months), and one of the largest numbers of medical team encounters (median, 38) before PC. Conclusions.: We found that a majority of cancer patients at our cancer center did not access PC before they died. PC referral occurs late in the disease process with many missed opportunities for referral.
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Patients with advanced cancer are often referred to palliative care late, even at oncology and palliative care reference centers.
“However, patients continue to receive late referrals to PC even in comprehensive cancer centers.”
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- Authors
- Hui, D., Kim, S.-H., Kwon, J. H., Tanco, K. C., Zhang, T., Kang, J. H., Rhondali, W., Chisholm, G., & Bruera, E.
- Affiliations
- The University of Texas MD Anderson Cancer Center (US)
- Corresponding author
- Hui, David
- ORCID
- Venue
- The Oncologist
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-12-01
- Volume
- 17
- Issue
- 12
- Pages
- 1574-1580
- ISSN
- 1083-7159 (ISSN-L)
- 1549-490X
- PMC
- PMC3528390
- OpenAlex
- W2149149861
- Cited by
- 218
- References
- 37
- Citations by year
- 2026: 2 · 2025: 12 · 2024: 20 · 2023: 10 · 2022: 18 · 2021: 11 · 2020: 24 · 2019: 25 · 2018: 23 · 2017: 15 · 2016: 15 · 2015: 19 · 2014: 15 · 2013: 7 · 2012: 1
- FWCI
- 12.98
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- The Oncologist (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Texas MD Anderson Cancer Center
- National Cancer Institute (P30CA016672)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- access to palliative care, palliative care referral, advanced cancer, comprehensive cancer center, hematologic malignancies, predictors of referral, referral timing
- MeSH terms
- Adult, Aged, Aged, 80 and over, Comprehensive Health Care, Female, Humans, Male, Middle Aged, Neoplasms, Palliative Care, Referral and Consultation, Retrospective Studies, Multivariate Analysis, Logistic Models, Young Adult
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